Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study

Background: When performing the Upper Limb Neurodynamic Test 1 (ULNT1), the order of joint movement can be varied to place more stress onto certain nerve segments. However, the mechanisms underlying this phenomenon are still unclear. This study aimed to analyze the differences in the stiffness of th...

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Main Authors: Gianluca Ciuffreda, Elena Estébanez-de-Miguel, Isabel Albarova-Corral, Miguel Malo-Urriés, Michael Shacklock, Alberto Montaner-Cuello, Elena Bueno-Gracia
Format: Article
Language:English
Published: MDPI AG 2024-12-01
Series:Diagnostics
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Online Access:https://www.mdpi.com/2075-4418/14/24/2881
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author Gianluca Ciuffreda
Elena Estébanez-de-Miguel
Isabel Albarova-Corral
Miguel Malo-Urriés
Michael Shacklock
Alberto Montaner-Cuello
Elena Bueno-Gracia
author_facet Gianluca Ciuffreda
Elena Estébanez-de-Miguel
Isabel Albarova-Corral
Miguel Malo-Urriés
Michael Shacklock
Alberto Montaner-Cuello
Elena Bueno-Gracia
author_sort Gianluca Ciuffreda
collection DOAJ
description Background: When performing the Upper Limb Neurodynamic Test 1 (ULNT1), the order of joint movement can be varied to place more stress onto certain nerve segments. However, the mechanisms underlying this phenomenon are still unclear. This study aimed to analyze the differences in the stiffness of the median nerve (MN) and the brachial plexus (BP) using ultrasound shear wave elastography during three sequences of the ULNT1: standard (ULNT1-STD), distal-to-proximal (ULNT1-DIST), and proximal-to-distal (ULNT1-PROX). Methods: Shear wave velocity (SWV) was measured at the initial and final position of each sequence at the MN (wrist) and at the C5 and C6 nerve roots (interscalene level) in 31 healthy subjects. Results: A significant interaction was found between ULNT1 sequence and location (<i>p</i> < 0.001). The ULNT1-STD and ULNT1-DIST induced a greater stiffness increase in the MN (5.67 ± 0.91 m/s, +113.94%; 5.65 ± 0.98 m/s, +115.95%) compared to C5 and C6 (<i>p</i> < 0.001). The ULNT1-PROX resulted in a significantly smaller increase in stiffness at the MN (4.13 ± 0.86 m/s, +54.17%, <i>p</i> < 0.001), but a greater increase at C5 (4.88 ± 1.23 m/s, +53.39%, <i>p</i> < 0.001) and at C6 (4.87 ± 0.81 m/s, +31.55%). The differences for the ULNT1-PROX at C6 were only significant compared to the ULNT1-STD (<i>p</i> < 0.001), but not the ULNT1-DIST (<i>p</i> = 0.066). Conclusions: BP and MN stiffness vary depending on the joint movement sequence during neurodynamic testing. However, the influence of the surrounding tissues may have affected SWV measurements; consequently, these results should be interpreted with caution.
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series Diagnostics
spelling doaj-art-602e945e9be9416c8a05b6ab8e2918d42024-12-27T14:21:03ZengMDPI AGDiagnostics2075-44182024-12-011424288110.3390/diagnostics14242881Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography StudyGianluca Ciuffreda0Elena Estébanez-de-Miguel1Isabel Albarova-Corral2Miguel Malo-Urriés3Michael Shacklock4Alberto Montaner-Cuello5Elena Bueno-Gracia6Department of Human Anatomy and Histology, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, SpainPhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, SpainPhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, SpainPhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, SpainNeurodynamic Solutions, Adelaide 5034, AustraliaPhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, SpainPhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, SpainBackground: When performing the Upper Limb Neurodynamic Test 1 (ULNT1), the order of joint movement can be varied to place more stress onto certain nerve segments. However, the mechanisms underlying this phenomenon are still unclear. This study aimed to analyze the differences in the stiffness of the median nerve (MN) and the brachial plexus (BP) using ultrasound shear wave elastography during three sequences of the ULNT1: standard (ULNT1-STD), distal-to-proximal (ULNT1-DIST), and proximal-to-distal (ULNT1-PROX). Methods: Shear wave velocity (SWV) was measured at the initial and final position of each sequence at the MN (wrist) and at the C5 and C6 nerve roots (interscalene level) in 31 healthy subjects. Results: A significant interaction was found between ULNT1 sequence and location (<i>p</i> < 0.001). The ULNT1-STD and ULNT1-DIST induced a greater stiffness increase in the MN (5.67 ± 0.91 m/s, +113.94%; 5.65 ± 0.98 m/s, +115.95%) compared to C5 and C6 (<i>p</i> < 0.001). The ULNT1-PROX resulted in a significantly smaller increase in stiffness at the MN (4.13 ± 0.86 m/s, +54.17%, <i>p</i> < 0.001), but a greater increase at C5 (4.88 ± 1.23 m/s, +53.39%, <i>p</i> < 0.001) and at C6 (4.87 ± 0.81 m/s, +31.55%). The differences for the ULNT1-PROX at C6 were only significant compared to the ULNT1-STD (<i>p</i> < 0.001), but not the ULNT1-DIST (<i>p</i> = 0.066). Conclusions: BP and MN stiffness vary depending on the joint movement sequence during neurodynamic testing. However, the influence of the surrounding tissues may have affected SWV measurements; consequently, these results should be interpreted with caution.https://www.mdpi.com/2075-4418/14/24/2881neurodynamicsbiomechanicsmedian nervebrachial plexusnerve rootselastography
spellingShingle Gianluca Ciuffreda
Elena Estébanez-de-Miguel
Isabel Albarova-Corral
Miguel Malo-Urriés
Michael Shacklock
Alberto Montaner-Cuello
Elena Bueno-Gracia
Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study
Diagnostics
neurodynamics
biomechanics
median nerve
brachial plexus
nerve roots
elastography
title Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study
title_full Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study
title_fullStr Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study
title_full_unstemmed Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study
title_short Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study
title_sort impact of neurodynamic sequencing on the mechanical behaviour of the median nerve and brachial plexus an ultrasound shear wave elastography study
topic neurodynamics
biomechanics
median nerve
brachial plexus
nerve roots
elastography
url https://www.mdpi.com/2075-4418/14/24/2881
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